A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system

Abstract

Background: Three-dimensional (3D) electroanatomical navigation systems decrease the fluoroscopy time of electrophysiology and ablation procedures. The aim of this study was to assess the safety and efficacy of a complete nonfluoroscopic approach for electrophysiologic studies and right-sided catheter ablations for supraventricular tachycardia in patients with normal cardiac anatomy using a 3D, surface electrode-based navigation system (NavX, St. Jude Medical, St. Paul, MN, USA).

Methods and results: Electrophysiologic studies were performed in 26 consecutive cases (12.7 +/- 7.5 years) using NavX without fluoroscopy. The procedure time was 98.7 +/- 49.7 minutes. Nonfluoroscopic catheter ablations were performed in 24 of 28 consecutive patients. Cryoablation was used in 23 of 24. The procedure time was 193.5 +/- 80 minutes. The coronary sinus access was obtained in 32.1 +/- 12 (range: 15-60) seconds. No complications occurred. All patients (n = 19) who underwent cryoablation for right-sided arrhythmia substrates with conventional fluoroscopic guidance in addition to NavX were used as a control group (10.1 +/- 5.2 years). Catheter ablation success rate of the control group (16/19, 84%) was not significantly different compared to the patients who underwent ablation without fluoroscopy (22/24, 92%). The procedure time was also not significantly different between the two groups (P = NS).

Conclusion: This study demonstrates that nonfluoroscopic electrophysiologic studies and right-sided catheter ablations for supraventricular tachycardia can be safely and effectively performed in the majority of patients with normal cardiac anatomy using NavX. Further studies will be necessary in order to establish the potential utility of NavX in eliminating or decreasing radiation exposure for other electrophysiology procedures.